A recent analysis has found that stopping preventive medications in frail, elderly adults does not increase the risk of death, hospitalisation, or major heart-related events. The study, published in the journal BioMed Central (BMC) Geriatrics, also reported no significant link between de-prescribing and an increased risk of falls, fractures, or a reduced quality of life.

Researchers, including teams from the Indian Council of Medical Research-National Institute for Research in Bacterial Infections, Kolkata, and Sweden's Karolinska Institutet, conducted a review of 15 previously published studies involving more than 33,000 participants. They examined outcomes for older adults with advanced frailty, dementia, or limited life expectancy who were either continuing long-term preventive medications or had them withdrawn.

The medications studied included antihypertensives, statins, and antidiabetics, commonly prescribed to elderly patients despite uncertain benefits and the potential risks of “polypharmacy,” where multiple drugs are taken simultaneously. Frail older adults are particularly vulnerable to complications from long-term medication use, prompting growing interest in the practice of de-prescribing.

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The analysis found that de-prescribing preventive medications was not associated with higher all-cause mortality, hospitalisation, or major adverse cardiovascular events (MACE). It also did not increase the risk of falls, fractures, or deterioration in quality of life. The only notable effect observed was a slight rise in systolic blood pressure among those whose antihypertensive medications were withdrawn.

Despite these encouraging findings, the researchers cautioned that the overall certainty of the evidence remains low. They emphasized that further high-quality studies are needed to strengthen confidence in the safety and outcomes of de-prescribing in elderly, frail populations.

The study provides important guidance for clinicians and caregivers seeking to balance the benefits and risks of long-term preventive medications in older adults. By carefully evaluating the necessity of each drug, healthcare providers can potentially reduce the burden of polypharmacy while maintaining patient safety and quality of life.

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